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Chiropractic & Manual Therapies
Published in: Chiropractic & Manual Therapies 1/2019

Open Access 01-12-2019 | Research

Promoting the use of self-management in patients with spine pain managed by chiropractors and chiropractic interns: barriers and design of a theory-based knowledge translation intervention

Authors: Owis Eilayyan, Aliki Thomas, Marie-Christine Hallé, Sara Ahmed, Anthony C. Tibbles, Craig Jacobs, Silvano Mior, Connie Davis, Roni Evans, Michael J. Schneider, Heather Owens, Fadi Al Zoubi, Jan Barnsley, Cynthia R. Long, Andre Bussières

Published in: Chiropractic & Manual Therapies | Issue 1/2019

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Abstract

Background

The literature supports the effectiveness of self-management support (SMS) to improve health outcomes of patients with chronic spine pain. However, patient engagement in SMS programs is suboptimal. The objectives of this study were to: 1) assess participation in self-care (i.e. activation) among patients with spine pain, 2) identify patients’ barriers and enablers to using SMS, and 3) map behaviour change techniques (BCTs) to key barriers to inform the design of a knowledge translation (KT) intervention aimed to increase the use of SMS.

Methods

In summer 2016, we invited 250 patients with spine pain seeking care at the Canadian Memorial Chiropractic College in Ontario, Canada to complete the Patient Activation Measure (PAM) survey to assess the level of participation in self-care. We subsequently conducted individual interviews, in summer 2017, based on the Theoretical Domains Framework (TDF) in a subset of patients to identify potential challenges to using SMS. The interview guide included 20 open-ended questions and accompanying probes. Findings were deductively analysed guided by the TDF. A panel of 7 experts mapped key barriers to BCTs, designed a KT intervention, and selected the modes of delivery.

Results

Two hundred and twenty-three patients completed the PAM. Approximately 24% of respondents were not actively involved in their care. Interview findings from 13 spine pain patients suggested that the potential barriers to using SMS corresponded to four TDF domains: Environmental Context and Resources; Emotion; Memory, Attention & Decision-Making; and Behavioural Regulation. The proposed theory-based KT intervention includes paper-based educational materials, webinars and videos, summarising and demonstrating the therapeutic recommendations including exercises and other lifestyle changes. In addition, the KT intervention includes Brief Action Planning, a SMS strategy based on motivational interviewing, along with a SMART plan and reminders.

Conclusions

Almost one quarter of study participants were not actively engaged in their spine care. Key barriers likely to influence uptake of SMS among patients were identified and used to inform the design of a theory-based KT intervention to increase their participation level. The proposed multi-component KT intervention may be an effective strategy to optimize the quality of spine pain care and improve patients’ health-outcomes.
Appendix
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Metadata
Title
Promoting the use of self-management in patients with spine pain managed by chiropractors and chiropractic interns: barriers and design of a theory-based knowledge translation intervention
Authors
Owis Eilayyan
Aliki Thomas
Marie-Christine Hallé
Sara Ahmed
Anthony C. Tibbles
Craig Jacobs
Silvano Mior
Connie Davis
Roni Evans
Michael J. Schneider
Heather Owens
Fadi Al Zoubi
Jan Barnsley
Cynthia R. Long
Andre Bussières
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Chiropractic & Manual Therapies / Issue 1/2019
Electronic ISSN: 2045-709X
DOI
https://doi.org/10.1186/s12998-019-0267-6

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